New Development in Brain Monitoring for Cardiac Surgery

Jarry, Stéphanie; Couture, Étienne J.; Falih, Jawad; Lebon, Jean-Sébastien; Ayoub, Christian; Rochon, Antoine; Rousseau-Saine, Nicolas; Denault, André

doi:10.1016/j.cjca.2022.11.006

Cited by 5 publications

(2 citation statements)

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“…Thus, temporary shifting to Trendelenburg position can effectively result in central volume augmentation and restorations of MAP and coronary blood flow, in addition to facilitating exposure of the lateral or posterior wall target vessels [34]. However, caution is required to avoid cerebral venous congestion from impaired venous drainage caused by prolonged and extreme Trendelenburg position combined with RV compression by stabilizers, which may yield adverse neurologic outcome [35].…”

Section: Preloadmentioning

confidence: 99%

“…For instance, Trendelenburg position combined with RV compression and impaired cerebral venous drainage during lateral wall grafting that subsequently resulted in emergence delirium was manifested as a significant cerebral desaturation through increased deoxyhemoglobin variation (indicating venous congestion) and burst suppression detected by Root O3 cerebral oximetry (Masimo, Irvine, CA, USA) and processed electroencephalography, respectively [35]. In line with these observations, systemic venous congestion elicited by the mechanical RV compression and dysfunction may result in renal, hepatic, or portal venous congestion.…”

Section: Making (Video Clip 4)mentioning

confidence: 99%

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Hemodynamic management during off-pump coronary artery bypass surgery: a narrative review of proper targets for safe execution and troubleshooting

Shim

Kim

Couture

et al. 2023

Korean J Anesthesiol

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Off-pump coronary surgery requires mechanical cardiac displacement yielding bi-ventricular systolic and diastolic dysfunction. Although transient, subsequent hemodynamic deterioration can bear dismal prognosis and at the extreme, emergent on-pump conversion may be needed, which is associated with undesirably high morbidity and mortality rates. Thus, proper decisions should be made based on objective hemodynamic targets whether surgery can be proceeded before opening the coronary artery.Hemodynamic management should prioritize the avoidance of perplexing myocardial oxygen-supply demand balance, which include maintenance of mean arterial pressure above 70 mmHg while avoiding increase in oxygen demand beyond the patient's coronary reserve. Maintenance of mixed venous oxygen saturation above 60%, which reflects the lower limit of the adequacy of global oxygen-supply demand balance, seems also important not to jeopardize the patient's prognosis. Above all, severe mechanical cardiac constraint incurring compressive syndromes that cannot by overcome by manipulating major determinants of cardiac output should be avoided. To rule out uncompromising form of cardiac constraint, central venous pressure should not equal or exceed the pulmonary artery diastolic (or occlusion) pressure, which would reflect tamponade physiology. In addition, transesophageal echocardiography should rule out mechanical cardiac displacementinduced ventricular interdependence, dyskinesia, severe mitral regurgitation, and left ventricular outflow tract obstruction with or without systolic motion of the anterior leaflet of the mitral valve, which cannot be tolerated during the period of grafting. Also, careful inspection for gas bubbles in the ascending aorta should be performed to prevent rare causes of hemodynamic collapse by massive gas embolism obstructing the right coronary ostium.

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Section: Preloadmentioning

confidence: 99%

Section: Making (Video Clip 4)mentioning

confidence: 99%